Provider Demographics
NPI:1265452726
Name:GARBER, LISA RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RUTH
Last Name:GARBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 S SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4650
Mailing Address - Country:US
Mailing Address - Phone:323-655-6794
Mailing Address - Fax:
Practice Address - Street 1:566 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4650
Practice Address - Country:US
Practice Address - Phone:323-655-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALX12653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW12653Medicare UPIN